Provider Demographics
NPI:1063926780
Name:NAVARRO, KELSEY (OTR/L)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:NAVARRO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4247 54TH PL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-6002
Mailing Address - Country:US
Mailing Address - Phone:909-771-8160
Mailing Address - Fax:
Practice Address - Street 1:4247 54TH PL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-6002
Practice Address - Country:US
Practice Address - Phone:909-771-8160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-17
Last Update Date:2025-12-03
Deactivation Date:2019-11-22
Deactivation Code:
Reactivation Date:2025-12-03
Provider Licenses
StateLicense IDTaxonomies
CA16786225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty